Individual
DR. MATTHEW HARRY LEE WILKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701
(903) 606-5864
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
R4649
TX
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
R4649
TX
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
R4649
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
387308503
—
TX
01
—
820877
MEDICARE
TX
Enumeration date
06/03/2013
Last updated
03/27/2024
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